Spreader graft insertion

A spreader graft (2 cm×4 mm) was inserted on either sides of the nasal septal dorsum and secured in place with 5-0 Polydioxanone (PDS) sutures. The medial edge of the upper lateral cartilages was then sutured to the spreader grafts and to each other in the midline, using the same type of sutures, creating a slightly wider nasal septal angle (Figure 4).

The spreader grafts (SG) are inserted and secured in place between the nasal septum (NS) and the upper lateral cartilages (ULCs).

Flaring sutures were then performed using the lateral suspension technique (5). The upper lateral cartilages were bilaterally sutured at a distance equal to half the width of the cartilage over the nasal bridge using a 5-0 PDS suture (Figure 5).

Lateral suspension sutures are placed at a distance equal to half the width of the upper lateral cartilage (ULC). The curved arrows indicate the direction of suturing. The sutures are secured in the midline over the nasal bridge.

NS: nasal septum; SG: spreader grafts

Endoscopic examination of the nasal cavity was then performed to ensure adequate widening of the internal nasal valve angle. Mattress suturing of the nasal septal mucosa eliminating sub-perichondrial dead space, was performed using 5-0 polyglactin sutures; the columellar incision was finally closed using 5-0 polypropylene sutures.

The patients were followed-up weekly for a month, then monthly for 3 months, and every 6 months for up to 3 years. All measurements were repeated during the last follow uo visit.